The Temple-led Emergency care research network comprised of multiple community and academic medical centers and EMS providers throughout Philadelphia, eastern PA and NJ have effectively conducted clinical trials together since 2007. To meet the needs for specific study enrollment, the group has grown from 2 to now 5 actively enrolling sites and is prepared to expand to 10 hospitals with the highest volume emergency and trauma centers and 6 of the busiest EMS systems all with an expressed interest in participating in pre- hospital research to cover the entire Philadelphia metro area and the suburban and rural areas that surround it. This large hub-spoke network spans very diverse populations including extremely poor, mostly African American and Hispanic communities in densely populated cities such as Philadelphia, Chester and Reading, to highly affluent areas in suburban Montgomery county, and to rural Bucks and Berks county in PA Dutch country. Temple-SIREN hub and spoke leaders have had career-long commitment to emergency care and are active in translational, pre-hospital and clinical research in heart failure and cardiac arrest, respiratory distress, disorders of coagulation and treatment of exsanguination, acute stroke and traumatic brain injury and severe penetrating and blunt trauma, all fertile ground for SIREN studies. These clinician-scientists in Emergency Medicine, Cardiology, Pulmonary, Hematology, Neurocritical, and Trauma care are leaders in their fields and set the standards for care for patients with acute illness and injury. Through collaboration and hub oversight, the Temple-SIREN group expects to significantly contribute SIREN studies' enrollment. In addition, we plan to stay ahead of the curve by translating preclinical work to the bedside and using our highly diverse regional network for population studies to address racial and social determinants of emergency care in our region. The Temple-SIREN HUB staff plans to work closely with participating site investigators and coordinators from multiple disciplines to efficiently execute SIREN studies. Mechanisms to enhance efficiency and quality of clinical research across sites include use of a common informatics system to identify potential study patients; frequent communication with investigators and coordinators via webinars and conference calls; diligent site management focused on good clinical research practices and compliance and yearly HUB-spoke meetings to provide additional training by study role. Temple-SIREN investigators and coordinators are expect to work with the SIREN clinical coordinating center and data management center and ad hoc working groups to design and operationalize SIREN studies. The Temple-SIREN HUB team would benefit from participating in this coordinated approach to emergency care research as would the people of Philadelphia and the surrounding communities served by our hospitals and EMS systems.